What is monkeypox? Monkeypox is a rare disease that is caused by infection with monkeypox virus. The virus is a pox virus that was first discov- ered in monkeys in 1958, hence the name. It is believed that the virus naturally lives and reproduces in rodents in central and western Africa. The first human case of monkeypox was identified in the Democratic Republic of Congo in 1970, and it has also been found in other central and western African countries. Past outbreaks have typically involved a relative- ly small number of cases among residents of rural hunting villages in the African rainforest. Over the past half century there have been several outbreaks of monkeypox in other parts of the world, including an outbreak in the U.S. in 2003 related to Gambian giant rats imported by an exotic pet dealer. For more information see the Centers for Disease Control and Prevention (CDC) website section on monkeypox. Why is monkeypox suddenly in the news? In May 2022 about 200 verified and suspected cases of monkeypox were reported in Europe, North America, Israel, and Australia. All but one case occurred among men, and many were among gay and bisexual men. No one is known to have died in the current outbreak. How is monkeypox spread? According to the Centers for Disease Control and Prevention: “Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to- face contact. Monkeypox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkeypox sores. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.” While monkeypox is not a traditional sexually transmitted infection, it appears that it can be transmitted through prolonged physical contact, such as through sexual intimacy and even prolonged kissing (“making out”). Several individuals diagnosed with monkeypox engaged in sex with new partners, so they may have contracted monkeypox through sexual behavior. What are the symptoms? Symptoms include fever, headache, muscle aches, exhaustion, chills, and swollen lymph nodes. Usually within 1-3 days an individual with monkeypox develops a rash and then lesions, which progress through a number of phases before bursting as pustules, scabbing, and falling off. The illness usually lasts 2-4 weeks. The current outbreak is believed to be of the western African variant, which is relatively milder than the central African version. For more information see the CDC’s list of monkeypox symptoms. Monkeypox and gay and bisexual men: Fact sheet
Monkeypox and gay and bisexual men: Fact sheet
Aug 02, 2022
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What is monkeypox? Monkeypox is a rare disease that is caused by infection with monkeypox virus. The virus is a pox virus that was first discov- ered in monkeys in 1958, hence the name. It is believed that the virus naturally lives and reproduces in rodents in central and western Africa. The first human case of monkeypox was identified in the Democratic Republic of Congo in 1970, and it has also been found in other central and western African countries. Past outbreaks have typically involved a relative- ly small number of cases among residents of rural hunting villages in the African rainforest. Over the past half century there have been several outbreaks of monkeypox in other parts of the world, including an outbreak in the U.S. in 2003 related to Gambian giant rats imported by an exotic pet dealer. For more information see the Centers for Disease Control and Prevention (CDC) website section on monkeypox.
Why is monkeypox suddenly in the news? In May 2022 about 200 verified and suspected cases of monkeypox were reported in Europe, North America, Israel, and Australia. All but one case occurred among men, and many were among gay and bisexual men. No one is known to have died in the current outbreak.
How is monkeypox spread? According to the Centers for Disease Control and Prevention:
“Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to- face contact. Monkeypox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkeypox sores. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.”
While monkeypox is not a traditional sexually transmitted infection, it appears that it can be transmitted through prolonged physical contact, such as through sexual intimacy and even prolonged kissing (“making out”). Several individuals diagnosed with monkeypox engaged in sex with new partners, so they may have contracted monkeypox through sexual behavior.
What are the symptoms? Symptoms include fever, headache, muscle aches, exhaustion, chills, and swollen lymph nodes. Usually within 1-3 days an individual with monkeypox develops a rash and then lesions, which progress through a number of phases before bursting as pustules, scabbing, and falling off. The illness usually lasts 2-4 weeks. The current outbreak is believed to be of the western African variant, which is relatively milder than the central African version. For more information see the CDC’s list of monkeypox symptoms.
Monkeypox and gay and bisexual men: Fact sheet
How do I protect myself against monkeypox? During the current outbreak, you may want to avoid large gatherings such as raves and dance parties where you may have close body contact with others. In the short-term you may also want to avoid physical intimacy with strangers whose health status and recent travel history you are not familiar with. You may want to ask new part- ners about whether they have any of the early symptoms of monkeypox, such as fevers, swollen glands, body aches, or a rash. These symptoms may be due to many other infections, but it will be good for those partners to seek medical care be- fore engaging in any sexual activity. It is probably also a good idea to avoid sex clubs and saunas for the time being. But if you’re going to them—or pri- vate sex parties—minimizing physical contact and partners is a way to reduce your risk.
Emory University infectious disease specialist Dr. Boghuma Titanji emphasized the risk of close contact in an article in Poz magazine:
“Close contact is not only sexual contact,” said Boghuma Titanji, MD, PhD, an infectious disease specialist at Emory University in Atlanta. “If you are at a crowded concert, bar, or club, body to body with other people, that’s close contact too. All forms of sexual contact are close contact. In- fectious pathogens flourish with the right timing and opportunity. That’s how outbreaks occur.”
Individuals who are close contacts with someone who has been diagnosed with monkeypox may benefit from smallpox vaccine up to two weeks af- ter exposure. If you are a close contact with some- one diagnosed with monkeypox please contact a health care provider immediately.
There is no evidence that condoms or pre-expo- sure prophylaxis (PrEP) for HIV prevention are ef- fective in protecting against monkeypox.
What should I do if I think I have monkeypox? During a media briefing held Monday, May 23, CDC epidemiologist John Brooks, MD, of the CDC’s Di- vision of HIV/AIDS Prevention said that anyone with a new or unexplained rash or other symptoms should see their healthcare provider and raise the possibility that the rash may be a symptom of monkeypox. “Don’t hesitate to advocate for your health and inform your doctor of your concerns
if you think you may have been exposed,” Brooks said. During the same briefing, Capt. Jennifer Mc- Quiston, DVM, MS, Deputy Director of the CDC’s Division of High Consequence Pathogens and Pa- thology, said that most people typically recover from monkeypox within four to six weeks. You can listen to the briefing in full at this link.
What does monkeypox have to do with gay and bisexual men and other MSM? The current outbreak of monkeypox in Europe and North America appears to be related to two raves held recently in Spain and Belgium and at- tended primarily by gay men, according to David Heymann, Professor of Infectious Diseases at the London School of Hygiene and Tropical Medicine, and an advisor to the World Health Organization. The virus was likely transmitted via sexual contact,
Heymann theorized. However, as sexual contact involves close physical contact, distinguishing be- tween the two in terms of contribution to trans- mission would be difficult. The CDC subsequently issued an alert during the May 23 media briefing warning gay and bisexual men that the virus ap- pears to be spreading in the community globally.
Is monkeypox a gay disease? No. Monkeypox appears to be spreading now among some sexual and social networks of gay and bisexual men and other men who have sex with men (MSM). However, there is no such thing as a gay disease. Viruses and bacteria can and do infect anyone regardless of sexual orientation. It is also not a sexually transmitted infection. Instead, it is spread through close contact, as previously described. Anyone can get monkeypox, including heterosexual people, women, transgender and nonbinary people, and others.
It is important not to stereotype gay and bisexual men and/or Africans as bearers of disease. Gay and bisexual men and African immigrants already experience significant stigma and prejudice and are vulnerable to discrimination
and violence victimization. Stigma about gay and bisexu- al people, including laws criminalizing homosexuality and same-sex behavior which still exist in many countries, may cause men who have sex with men to fear disclosing their same-sex behavior. This may also make them reluctant to disclose that they are part of social and sexual networks that are disproportionately affected by the current out- break, making prevention of the spread of monkeypox more difficult. The public health response to this outbreak of monkeypox should not be allowed to exacerbate ho- mophobia and racism and the scapegoating of gay and bisexual men and African immigrants.
Acknowledgements
Written by Sean Cahill, PhD, Director of Health Policy Research, The Fenway Institute.
Reviewed by Kenneth Mayer, MD, Medical Research Director, Fenway Health, Co-Director, The Fenway Institute, Professor of Medicine, Harvard Medical School, Attending Physician, Infectious Disease Division, Beth Israel Deaconess Hospital; Ami Multani, MD, Medical Director of Infectious Disease, Fenway Health; Gregg Gonsalves, PhD, Associate Professor of Epidemiology, Yale School of Public Health, codirector of the Global Health Justice Partnership; Brian Bakofen, DO, Interim Medical Director, Fenway Health; Carl Sciortino, Executive Vice President of External Relations, Fenway Health.
Copyright May 2022 The Fenway Institute.
What about people living with HIV? There are no known cases of monkeypox in people living with HIV. Since immunosuppression may lead to more serious cases of monkeypox, it is important that people with HIV be on effective antiretroviral therapy, so their immune systems are able to fight back against the monkeypox virus.
Is treatment available? According to the CDC web page on this topic, dated July 16, 2021: For purposes of controlling a monkeypox outbreak in the United States, smallpox vaccine, antivirals, and vaccinia immune globulin (VIG) can be used.
Where can I learn more information? As more information is made available by the CDC and Massachusetts DPH, Fenway Health will help elevate this information on our website. You can also check the CDC’s information about monkey- pox and the state’s Department of Public Health’s information about monkeypox.
TFIR-337
Why is monkeypox suddenly in the news? In May 2022 about 200 verified and suspected cases of monkeypox were reported in Europe, North America, Israel, and Australia. All but one case occurred among men, and many were among gay and bisexual men. No one is known to have died in the current outbreak.
How is monkeypox spread? According to the Centers for Disease Control and Prevention:
“Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to- face contact. Monkeypox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkeypox sores. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.”
While monkeypox is not a traditional sexually transmitted infection, it appears that it can be transmitted through prolonged physical contact, such as through sexual intimacy and even prolonged kissing (“making out”). Several individuals diagnosed with monkeypox engaged in sex with new partners, so they may have contracted monkeypox through sexual behavior.
What are the symptoms? Symptoms include fever, headache, muscle aches, exhaustion, chills, and swollen lymph nodes. Usually within 1-3 days an individual with monkeypox develops a rash and then lesions, which progress through a number of phases before bursting as pustules, scabbing, and falling off. The illness usually lasts 2-4 weeks. The current outbreak is believed to be of the western African variant, which is relatively milder than the central African version. For more information see the CDC’s list of monkeypox symptoms.
Monkeypox and gay and bisexual men: Fact sheet
How do I protect myself against monkeypox? During the current outbreak, you may want to avoid large gatherings such as raves and dance parties where you may have close body contact with others. In the short-term you may also want to avoid physical intimacy with strangers whose health status and recent travel history you are not familiar with. You may want to ask new part- ners about whether they have any of the early symptoms of monkeypox, such as fevers, swollen glands, body aches, or a rash. These symptoms may be due to many other infections, but it will be good for those partners to seek medical care be- fore engaging in any sexual activity. It is probably also a good idea to avoid sex clubs and saunas for the time being. But if you’re going to them—or pri- vate sex parties—minimizing physical contact and partners is a way to reduce your risk.
Emory University infectious disease specialist Dr. Boghuma Titanji emphasized the risk of close contact in an article in Poz magazine:
“Close contact is not only sexual contact,” said Boghuma Titanji, MD, PhD, an infectious disease specialist at Emory University in Atlanta. “If you are at a crowded concert, bar, or club, body to body with other people, that’s close contact too. All forms of sexual contact are close contact. In- fectious pathogens flourish with the right timing and opportunity. That’s how outbreaks occur.”
Individuals who are close contacts with someone who has been diagnosed with monkeypox may benefit from smallpox vaccine up to two weeks af- ter exposure. If you are a close contact with some- one diagnosed with monkeypox please contact a health care provider immediately.
There is no evidence that condoms or pre-expo- sure prophylaxis (PrEP) for HIV prevention are ef- fective in protecting against monkeypox.
What should I do if I think I have monkeypox? During a media briefing held Monday, May 23, CDC epidemiologist John Brooks, MD, of the CDC’s Di- vision of HIV/AIDS Prevention said that anyone with a new or unexplained rash or other symptoms should see their healthcare provider and raise the possibility that the rash may be a symptom of monkeypox. “Don’t hesitate to advocate for your health and inform your doctor of your concerns
if you think you may have been exposed,” Brooks said. During the same briefing, Capt. Jennifer Mc- Quiston, DVM, MS, Deputy Director of the CDC’s Division of High Consequence Pathogens and Pa- thology, said that most people typically recover from monkeypox within four to six weeks. You can listen to the briefing in full at this link.
What does monkeypox have to do with gay and bisexual men and other MSM? The current outbreak of monkeypox in Europe and North America appears to be related to two raves held recently in Spain and Belgium and at- tended primarily by gay men, according to David Heymann, Professor of Infectious Diseases at the London School of Hygiene and Tropical Medicine, and an advisor to the World Health Organization. The virus was likely transmitted via sexual contact,
Heymann theorized. However, as sexual contact involves close physical contact, distinguishing be- tween the two in terms of contribution to trans- mission would be difficult. The CDC subsequently issued an alert during the May 23 media briefing warning gay and bisexual men that the virus ap- pears to be spreading in the community globally.
Is monkeypox a gay disease? No. Monkeypox appears to be spreading now among some sexual and social networks of gay and bisexual men and other men who have sex with men (MSM). However, there is no such thing as a gay disease. Viruses and bacteria can and do infect anyone regardless of sexual orientation. It is also not a sexually transmitted infection. Instead, it is spread through close contact, as previously described. Anyone can get monkeypox, including heterosexual people, women, transgender and nonbinary people, and others.
It is important not to stereotype gay and bisexual men and/or Africans as bearers of disease. Gay and bisexual men and African immigrants already experience significant stigma and prejudice and are vulnerable to discrimination
and violence victimization. Stigma about gay and bisexu- al people, including laws criminalizing homosexuality and same-sex behavior which still exist in many countries, may cause men who have sex with men to fear disclosing their same-sex behavior. This may also make them reluctant to disclose that they are part of social and sexual networks that are disproportionately affected by the current out- break, making prevention of the spread of monkeypox more difficult. The public health response to this outbreak of monkeypox should not be allowed to exacerbate ho- mophobia and racism and the scapegoating of gay and bisexual men and African immigrants.
Acknowledgements
Written by Sean Cahill, PhD, Director of Health Policy Research, The Fenway Institute.
Reviewed by Kenneth Mayer, MD, Medical Research Director, Fenway Health, Co-Director, The Fenway Institute, Professor of Medicine, Harvard Medical School, Attending Physician, Infectious Disease Division, Beth Israel Deaconess Hospital; Ami Multani, MD, Medical Director of Infectious Disease, Fenway Health; Gregg Gonsalves, PhD, Associate Professor of Epidemiology, Yale School of Public Health, codirector of the Global Health Justice Partnership; Brian Bakofen, DO, Interim Medical Director, Fenway Health; Carl Sciortino, Executive Vice President of External Relations, Fenway Health.
Copyright May 2022 The Fenway Institute.
What about people living with HIV? There are no known cases of monkeypox in people living with HIV. Since immunosuppression may lead to more serious cases of monkeypox, it is important that people with HIV be on effective antiretroviral therapy, so their immune systems are able to fight back against the monkeypox virus.
Is treatment available? According to the CDC web page on this topic, dated July 16, 2021: For purposes of controlling a monkeypox outbreak in the United States, smallpox vaccine, antivirals, and vaccinia immune globulin (VIG) can be used.
Where can I learn more information? As more information is made available by the CDC and Massachusetts DPH, Fenway Health will help elevate this information on our website. You can also check the CDC’s information about monkey- pox and the state’s Department of Public Health’s information about monkeypox.
TFIR-337
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